HAC Healthcare Analyst Risk Assessment & Compliance 3

Question 1

A healthcare analyst is performing a HIPAA risk analysis. Which NIST publication provides the most widely used framework for this process?

Accepted Answer

NIST SP 800-66

Answer

NIST SP 800-66 (An Introductory Resource Guide for Implementing the HIPAA Security Rule) is specifically tailored to help organizations conduct HIPAA security risk assessments.

Question 2

Which type of healthcare fraud involves billing for services at a higher complexity level than was actually provided?

Accepted Answer

Upcoding

Answer

Upcoding is the practice of submitting claims for more complex or expensive services than were actually rendered, inflating reimbursement from payers.

Question 3

A hospital's compliance audit finds that certain CPT codes are routinely billed separately when they should be billed together under one code. This is an example of:

Accepted Answer

Unbundling

Answer

Unbundling involves separately billing individual components of a procedure that should be billed together under a single bundled CPT code, resulting in higher reimbursement.

Question 4

In a healthcare risk matrix, what two dimensions are typically used to assess and prioritize risks?

Accepted Answer

Likelihood and impact

Answer

A standard risk matrix plots risks on the axes of likelihood (probability of occurrence) and impact (severity of consequences) to prioritize mitigation efforts.

Question 5

What is the primary purpose of a healthcare organization's Internal Audit function in relation to compliance?

Accepted Answer

To independently assess the effectiveness of internal controls and compliance processes

Answer

Internal Audit provides independent, objective assurance that compliance controls are functioning effectively and that identified risks are being appropriately managed.

(HAC) Healthcare Analyst Certification Practice Test

(HAC) Healthcare Analyst Certification Practice Test

HAC Healthcare Analyst Risk Assessment & Compliance 3